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Talk of Georgia-style full Medicaid expansion spurs bipartisan buzz at state Capitol

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Talk of Georgia-style full Medicaid expansion spurs bipartisan buzz at state Capitol


(GA Recorder)— The Gold Dome was aflutter during the first week of the legislative session over whether Georgia Republicans might move to fully expand Medicaid this year.

A high-ranking Republican leader elevated the issue further when he uttered the words “Medicaid expansion” during a prominent speech to Georgia’s business community Wednesday. House Speaker Jon Burns said House lawmakers “will continue to gather facts” about a “private option” for expanding Medicaid.

In particular, several GOP lawmakers have voiced interest in an Arkansas-style model, which purchases private insurance for individuals on the marketplace instead of adding more people to the state-run Medicaid program.

In a statement Friday, Republican Lt. Gov. Burt Jones sounded open to the concept. Jones has pressed for changes to the state’s business regulations for medical providers, and discussions about Medicaid expansion are happening alongside the debate over to what extent Georgia should remake its certificate of need rules.

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“I have never wavered on my position that expanding access to health care, especially in rural parts of the state, should be a priority for all Georgians,” Jones said.

“The legislative process allows for different options to be presented on a variety of issues. I look forward to addressing this critical issue this upcoming session to help make access to quality health care a reality, regardless of someone’s zip code.”

Gov. Brian Kemp delivering his State of the State address Thursday (Ross Williams/Georgia Recorder) 

This all represents what appears to be a softening of the decade-long resistance in Georgia to Medicaid expansion, which is a central piece of former President Barack Obama’s legacy. But one of the big questions of the session will be this: Does that shift in thinking extend to the governor’s mansion?

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Georgia Pathways to Coverage, the governor’s partial expansion program, has enrolled about 2,300 people since launching in July. About 345,000 are thought to be eligible for the Medicaid program, according to the state’s estimate.

Kemp’s spokesman, Garrison Douglas, said Wednesday that the governor “has championed and continues to support” Pathways and Georgia Access, which is a state-run exchange set to launch later this year.

The governor did not mention Pathways in his State of the State address Thursday even as he touted other elements of his signature health care plans, like a reinsurance program that has helped lower premiums.

Pathways has attracted national attention because it made Georgia the only state to have a work requirement as part of its Medicaid program, with it only applying to those who are newly eligible.

‘We say a rose by any other name is still a rose’

The low enrollment in Pathways has ratcheted up the pressure on Georgia Republicans to change course.

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Georgia – which has one of the highest uninsured rates in the country – is now one of 10 states that have not expanded Medicaid under the Affordable Care Act, with neighboring North Carolina recently expanding the health insurance program for the poor.

“This isn’t just a policy oversight; it is a moral failing,” state Sen. Nabilah Islam Parkes, a Lawrenceville Democrat, said at a press conference Thursday. “Hundreds of thousands of our people are left without adequate health care.”

But other Democrats and long-time health care advocates have expressed optimism over the recent chatter, even if the conversation is not centered on traditional Medicaid expansion.

“I’m hearing the same thing that others are hearing – that this is the year that we’re going to have some sort of Medicaid expansion,” Rep. Billy Mitchell, a Stone Mountain Democrat who chairs House minority caucus, told a reporter Thursday. “It may not be called Medicaid expansion because it’s not politically palatable to certain groups. We say a rose by any other name is still a rose.”

Rep. Michelle Au is a Johns Creek Democrat and anesthesiologist who led Wednesday’s meeting on Medicaid expansion. (Jill Nolin/Georgia Recorder) 
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Rep. Michelle Au, a Johns Creek Democrat who is an anesthesiologist, said she was encouraged that talk of any kind of Medicaid expansion is now happening in Georgia.

“Even having this conversation at all, and considering something in a serious way, is already way better than anything that we’ve seen for a decade,” Au said in an interview.

Au led a Democratic caucus-organized hearing on Medicaid expansion that filled a meeting room and had people standing in the hallways to hear health care experts, hospital representatives and others talk about the impact of Medicaid expansion on the state’s economy and the health of Georgians.

Au, who is a leading Democratic voice on health care issues in Georgia, has regularly held educational forums on Medicaid expansion. But this year’s event was different.

“There’s a feeling in the air: something has changed, and it’s like, we’re really talking about this. This might happen,” Au said. “And many of our holdout-state neighbors have recently changed – states that we have a lot in common with. So, it’s not unreasonable to go down this path to think that there is a chance this could happen.”

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Scott Raynes was among the speakers at Au’s meeting. Raynes is president and CEO of Brunswick-based Southeast Georgia Health System and was a member of the House committee that looked at ways to modernize the state’s certificate of need regulations.

“Let’s not get hung up on the fact that we are one of the last 10 or 11 to even explore this,” Raynes said. “Let’s take advantage of the learnings of those states before us and make a good decision. A good economic decision, a decision that is really apolitical if you will, and do what’s right on behalf of the citizens of the state of Georgia, and frankly, help the industry of health care within it.”

Laura Colbert, executive director of Georgians for a Healthy Future, which advocates for Medicaid expansion, had this message for those who attended the organization’s Health Care Unscrambled event held Thursday: “I’m not going to count our chickens before they hatch – we don’t have expansion yet – but it’s coming.”

Georgia Pathways

The governor has proposed spending $1.7 million in this year’s budget to integrate Pathways into the state’s eligibility system for Medicaid and other public aid services, which is a move that is intended to increase enrollment in the program and improve the effectiveness of caseworkers who are processing applications, according to the governor’s Office of Budget and Planning.

The funding would also connect the state’s system to Georgia Access as Georgia moves toward a state-based exchange for health insurance under the Affordable Care Act.

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Sen. Ben Watson, a Savannah Republican who chairs the Senate Health and Human Services Committee, encouraged advocates to help enroll more people in Georgia Pathways. Jill Nolin/Georgia Recorder 

Pathways slightly expanded eligibility for Medicaid coverage in Georgia but also requires participants to complete 80 hours each month of work, school or other qualifying activity, and critics have long warned that the reporting requirements to show the hours were completed would create a paperwork burden.

The program was approved under the Trump administration and then delayed by the Biden administration. Georgia moved forward with launching the program in July after successfully challenging the federal government in court.

The program’s federally approved waiver expires in the fall of 2025.

During a conversation about Medicaid expansion at the Health Care Unscrambled event Thursday, Savannah Republican Sen. Ben Watson praised the state’s reinsurance program and urged health care advocates to help enroll people in Pathways.

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“The one that’s been a bit of a challenge, and I would challenge you to help our patients to get enrolled, is that 100% on down,” said Watson, who chairs the Senate Health and Human Services Committee.

As Pathways is being rolled out, an army of state workers is also in the process of checking the eligibility of all 2.8 million people covered by Medicaid after the end of a pandemic-era federal rule that protected coverage during the public health crisis. Hundreds of thousands of Georgians are expected to lose coverage as part of what’s known as the unwinding.

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Georgia

Speakers at Georgia Capitol mark King holiday celebration with calls for unity • Georgia Recorder

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Speakers at Georgia Capitol mark King holiday celebration with calls for unity • Georgia Recorder


On Friday, Georgia’s top public defender encouraged government officials and the community to continue supporting programs that transform lives during the state’s 40th anniversary celebration of Martin Luther King Jr.

Federal and Georgia governments will be closed on Monday in observance of the King’s birthday holiday, celebrated every third Monday in January. In 1968, King was slain at the age of 39 after becoming the leading face of the nonviolent Civil Rights Movement fighting systemic racism Black people faced across the deep South and other parts of America. Omotayo Alli executive director of the Georgia Public Defender Council was the keynote speaker as more than 150 people attended the celebration held at the state Capitol.

During the ceremony, the Georgia Martin Luther King Jr. Advisory Council recognized this year’s winners of awards named after five former longtime Georgia residents who worked closely with King during the Civil Rights Era. King family members were presented a proclamation from the state honoring the civil rights icon’s holiday.

The event is organized by the Georgia Black Legislative Caucus and the state Department of Community Affairs.

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Republican Gov. Brian Kemp emphasized King’s commitment to non-violence while confronting the injustices of racial prejudice and segregation.

He called for continued efforts to promote unity and opportunity for all Georgians, urging personal actions aligned with King’s principles.

“From his early life, growing up in Atlanta throughout his travels across the country fighting injustice, was never content to look the other way when he came to confronting the problems of his days,” Kemp said.

The keynote address was delivered by Omotayo Alli, the first Black woman to serve as executive director of the Georgia Public Defender Council, overseeing several dozen offices across Georgia.

Alli discussed her four decade journey as a public defender, emphasizing her efforts to improve juvenile justice by creating educational opportunities for children in the system.

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Alli spoke about establishing a public defender program that provides opportunities for people who have gone through the criminal justice system to help them reintegrate into the community.

She describes her transition to working with juvenile cases, which led to her realize the high number of children in the justice system.

Alli said she took a personal interest in bettering the lives of young people in the justice system, by providing educational opportunities and other resources that are critical  in their rehabilitation. Young people obtaining their GED and learning job skills at a technical school opens opportunities to end a cycle of poverty, she said.

A number of events celebrating the legacy of King will continue on Monday across Georgia. The annual holiday event at the Atlanta church where King preached will be led by a different religious leader than in recent years. Ebenezer Baptist Church church pastor and U.S. Sen. Raphael Warnock will not attend Monday’s celebration of King since the Atlanta Democrat will be in Washington D.C.for the inauguration of Republican President Donald Trump.

The Ebenezer church’s keynote sermon will be delivered by North Carolina’s Bishop William J. Barber II,  who serves as president and senior  lecturer of Repairers of the Breach. Barber will reflect upon a critical moment for people of faith and to the injustices plaguing the nation, according to a news release.

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Bird flu cases shut down poultry exhibitions, sales in Georgia

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Bird flu cases shut down poultry exhibitions, sales in Georgia


ATLANTA, Ga. (Atlanta News First) – Bird flu cases were confirmed in a commercial poultry flock in northeast Georgia.

The state’s department of agriculture has suspended all poultry exhibitions, shows and sales until further notice.

This is the first confirmed case in a poultry operation in Georgia and the fifth overall case in the state. According to the Georgia Department of Agriculture, the operation had approximately 45,000 broiler breeders onsite.

Georgia Agriculture Commissioner Tyler Harper said, “This is a serious threat to Georgia’s #1 industry and the livelihoods of thousands of Georgians who make their living in our state’s poultry industry. We are working around the clock to mitigate any further spread of the disease and ensure that normal poultry activities in Georgia can resume as quickly as possible.”

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All commercial operations within a 6-mile radius have been placed under quarantine for at least two weeks.



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Georgia’s Pathways to Coverage Program – The First Year in Review Fact Sheet – Georgia Budget and Policy Institute

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Georgia’s Pathways to Coverage Program – The First Year in Review Fact Sheet – Georgia Budget and Policy Institute


In July 2023, Georgia launched the Pathways to Coverage program, which offers health care coverage to adults with lower incomes who do not have access to affordable health insurance. To be eligible they must work, attend school, volunteer or complete another qualifying activity for at least 80 hours per month. The program covers the cost of many of the same medical services as traditional Medicaid, including doctor visits, hospital stays and prescriptions. This fact sheet provides policymakers and advocates with an overview of the program’s first year and offers recommendations for improving upon the existing program design.

Here are some key takeaways based on the program’s first year:

Enrollment in the Pathways to Coverage program fell far short of expectations and need. More than 40% of Georgia’s counties still had fewer than 10 enrollees despite the state having one of the highest percentages of uninsured populations in the nation. If the state continues to enroll about 4,231 enrollees per year as it did in the first year and assuming no one is disenrolled, it will take more than 12 years to achieve the original five-year enrollment goal (52,509).

A cumbersome enrollment process and restrictive eligibility criteria appeared to contribute to the program’s low enrollment in the first year. Potentially eligible Georgians face a steep “paperwork” burden – from completing a lengthy online or paper application to compiling documents to verify qualifying activities and hours. Only about half of individuals who showed initial interest in applying to the program submitted a complete application. Preliminary data also indicate that at least one in every five denials for those who do submit a complete application is due to failure to meet the qualifying hours and activities requirement.

Pathways to Coverage is a costly program for Georgia taxpayers, and most spending through the end of the first year covered administrative expenses rather than health care benefits. Since the program was approved through the end of the first year of implementation, a total of almost $58 million in combined state and federal funds was spent on the program. That amounts to an average of $13,000 per enrollee. Spending on upgrades to Georgia’s online eligibility and enrollment system represents the largest proportion of total program costs and was almost five times higher than spending on healthcare benefits for enrollees.

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For current enrollment and program cost data, please visit the Data Tracker page at GeorgiaPathways.org

Beyond Year One: Recommendations and Next Steps

With Pathways to Coverage up for renewal in September 2025, the state has an opportunity to leverage lessons learned from the first year to make the program more effective and less costly and to streamline the bureaucratic red tape that burdens both enrollees and state agency staff.

Programmatic recommendations:

  1. Eliminate monthly reporting and premium collection
  2. Expand automated verification of qualifying hours and activities at initial application and yearly renewal using electronic data sources
  3. Expand work requirement exemptions (in alignment with SNAP exemptions) to enable eligible veterans, full-time parents of young children, former foster youth and others to access the program
  4. Make Pathways to Coverage an ‘opt-out’ versus an ‘opt-in’ program
  5. Improve education and outreach for potentially eligible Georgians
  6. Improve communication with applicants and enrollees

System-level recommendations:

  1. Modernize Georgia’s public benefits eligibility and enrollment infrastructure
  2. Increase transparency and public data reporting and open up opportunities for stakeholder engagement

For more context on each recommendation and for an additional list of transformational recommendations like full Medicaid expansion, please download the full report “Georgia’s Pathways to Coverage Program – The First Year in Review” from the Resources page at GeorgiaPathways.org.





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